For the past 15 months, our country has faced an unprecedented public health crisis as COVID-19 has infected over 33 million Americans and claimed almost 600,000 lives. African Americans in particular are experiencing COVID-19 death tolls exceeding 1 in 800 nationally, compared to white Americans who are experiencing a death toll of 1 in 3,125 nationally. California alone accounts for 11 percent of COVID-19 cases, and African American communities (6 percent of the state’s population) have been hit especially hard, accounting for 7.4 percent of deaths. As vaccines have become widely available, these numbers are decreasing but not fast enough—especially among pregnant people.
The science is there to prove safety, including a new study just released in the New England Journal of Medicine that looked at 35,691 pregnant participants between the ages of 16 and 54. The study showed that the mRNA vaccine for COVID-19 is not associated with any increase in adverse events to new mothers or infants when compared to their pre-pandemic non-vaccinated counterparts.
While the benefits of vaccination far outweigh the minimal risks, and data collected from pregnant women who have taken the COVID-19 vaccine so far has been overwhelmingly positive, vaccine hesitancy among expectant African Americans remains. Misinformation has led to a fear of how the COVID-19 vaccine adversely affects maternal health and fetal development.
A main source of doubt among African Americans stems from a distrust of vaccines due to institutional racism and historical inequities—most notably, the infamous Tuskegee Syphilis Study. Among pregnant African Americans, maternal and infant mortality rates are staggering, as they are four times more likely to die during childbirth than white women. The COVID-19 vaccine adds an extra layer of uncertainty, so physicians must take these concerns seriously and provide the right information about the vaccines to ease doubt while understanding the historical causes that contribute to vaccine hesitancy.
Johnson & Johnson (J&J)—one of the main distributors of the COVID-19 vaccine—is no stranger to controversy among African Americans. Last summer, a Missouri judge ordered J&J and a subsidiary to pay $2.1 billion in damages to women who developed ovarian cancer as a result of using J&J’s products with toxic ingredients, namely its baby powder that was long marketed to African American women. These product concerns are justified, but unlike the lack of transparency in the past, there’s plenty of data to support why the J&J COVID-19 vaccine should be taken.
In the clinical trials, 13 percent of participants were African American. As of April 30, 2021, data from the J&J vaccine shows just 88 cases of adverse reaction to the vaccine out of nearly 8 million doses administered, including only 36 cases of rare blood clots and one death. That means complications developing as a result of taking the J&J vaccine are very rare. The Pfizer and Moderna vaccines are also widely available and are the recommended choices for the sub-population of pregnant patients. Among a group of 30,000 participants, 10 percent were African American to ensure all people of color were represented in the findings. In addition, preliminary findings of mRNA COVID-19 vaccine safety in pregnant persons show that of 35,691 participants ages 16 to 54, adverse neonatal outcomes included preterm birth (9.4 percent) and small size for gestational age (3.2 percent) with no neonatal deaths.
All COVID-19 vaccines in development are being carefully evaluated in clinical trials and will be authorized or approved only if they substantially lower the risk of contracting COVID-19. That information should help encourage pregnant African Americans to get the vaccine now and not delay until after their babies are born.
As an African American doctor who has taken the vaccine, I feel a deep responsibility to create a safe space for pregnant African Americans and to ask questions to help them make an informed decision about taking the vaccine. I understand that a lack of healthcare access and underlying health conditions, including heart disease, high blood pressure, diabetes, and asthma, play a role in how COVID-19 can further impact overall maternal health. With these existing challenges, patients can rest assured that development of the COVID-19 vaccine is ongoing as new variants emerge and data is collected to show the effects on pregnant people more accurately.
As physicians, we must listen to our patients’ concerns respectfully, professionally, and compassionately while understanding the history that has led to a distrust of the COVID-19 vaccine. Regardless of a mother’s decision, these conversations serve as opportunities for us to remind patients to take other preventative measures to stay safe from COVID-19 and to make healthy life choices, particularly while pregnant. The risks associated with not getting vaccinated far exceed the risks of being vaccinated. Pregnancy is temporary, but making a decision that positively impacts the long-term health of parent and baby is key.
Dr. Calvin Johnson is an anesthesiologist at Cedars-Sinai Medical Center in Los Angeles who specializes in obstetric anesthesiology, regional anesthesiology, pediatric anesthesiology and pain medicine.
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